Posts Tagged ‘healthcare’

Before leaving on a nine-day vacation to Martha’s Vineyard, U.S. President Barack Obama held a 53-minute long press conference on Friday, August 9.

The president spent his entire introductory remarks in his first solo press conference since late April, on proposed changes to the government’s surveillance laws.

The four specific steps he laid out were ones intended to mollify outrage both from the American people and U.S. allies to issues of eavesdropping and other forms of privacy invasion raised in the wake of damaging security leaks by Edward Snowden about secret U.S. government mass surveillance programs to the press.

Those four steps include amending the relevant portion of the Patriot Act, provide oversight to the judges who are tasked with authorizing the specific surveillance programs, increasing transparency regarding the different programs, including creating a website “hub” which will allow U.S. citizens and our allies to better understand the programs, and creating an outside panel of experts to review the entire enterprise to ensure that the U.S. government can maintain the trust of the people and our allies. This review panel will be required to submit an initial report in 60 days and a final report by the end of the calendar year.

While he remained even-keeled throughout most of his ten minute presentation, the president allowed himself a few jabs at countries who have been harshly critical of the U.S. in the wake of the Snowden leaks.

It’s true we have significant capabilities. What’s also true is we show a restraint that many governments around the world don’t even think to do, refuse to show. That includes, by the way, some of America’s most vocal critics. We shouldn’t forget the difference between the ability of our government to collect information online, under strict guidelines and for narrow purposes, and the willingness of some other governments to throw their own citizens in prison for what they say online.

The president concluded his prepared remarks by praising domestic critics of the surveillance programs, going so far as saying, “our critics are also our patriots.” But in responding to one of the reporters called on who queried how far this magnanimous position extended, the president made crystal clear, “No, I don’t think Mr. Snowden was a patriot.”

Of the questions asked by reporters of the president, the majority dealt with some aspect of the Snowden/Russian relations/surveillance review issues, two dealt with healthcare, one was about the next Federal Reserve chairman, one was on immigration reform, one was whether the U.S. is going to capture and punish the people who attacked the U.S. outpost in Benghazi, and one was whether al Qaeda has actually been “decimated.”

In other words, it apparently was of only minor significance that an unprecedented shuttering of the official face, presence and voice of America across a vast swath of the globe was of merely minor significance to the entire White House press corps as well as to the president of the United States. No one asked – or was permitted to ask – what exactly led to the closure of the government buildings or when they were expected to re-open.

However, after the press conference ended, the State Department issued a statement that 18 of the 19 embassies and consulates which have been closed for a week will reopen on Sunday or Monday. The U.S. Embassy in Sanaa, Yemen, will remain closed, and almost all U.S. government personnel were ordered to leave Yemen last Tuesday because of the potential for terrorist attacks from al Qaeda in the Arabian Peninsula. In addition, the U.S. embassy in Lahore, Pakistan, “which closed yesterday due to a separate credible threat to that facility, will also remain closed.”

You’d think there would have been more of a focus on the real, ongoing terrorist threats to the United States than on, say, who will be the next Federal Reserve chairman or even on immigration reform, neither one of which threatens to murder, maim and savage Americans in the immediate future.

According to a report on Israel Channel 10, Shelly Yechimovitch, the head of the Labor party, said that if she is appointed Minister of Finance, she would increase healthcare taxes, legislate an inheritance tax, and increase the corporate tax rate.

As the great anchor of the election hits bottom, plummeting past feeder fish, political plankton and eyeless creatures that lurk in the depths of MSNBC and Current TV to rise during election season to lecture us on how angry we should be, the theme of the season is that the choice between Romney and Obama is the choice between big corporations and big government.

Most people have already been primed by decades of songs and shows to pick the right answer to this one. We know that corporate boardrooms are full of menacing characters who are always laundering money, dumping toxic waste on children’s playgrounds and plotting to blot out the sun. And then they temporarily step out to work in government for a few years before returning to do their sun-blotting duties.

A choice between big corporations and big government is a choice of choices and no choice at all. There isn’t much good that can be said about corporations, just as there isn’t much good that can be said about any branch of the government. The difference is that you have a choice whether to deal with a corporation or not. Unless the government mandates that you buy health insurance from one of them; because most cases where people are forced to do business with a corporation is due to government regulations.

Imagine a big corporation. A really big corporation that monopolizes as much as it can and compels you to buy its low quality overpriced services and imprisons you if you refuse to pay for them whether you use them or not.

Now imagine a CEO who has no accountability, who cannot be put on trial for his actions while serving in that position, who picks and chooses which laws to follow, who breaks the law, causes thousands of deaths, lies repeatedly and wants to spend another four years doing it all over again.

We are all shareholders of the corporation of government. A corporation whose board and CEO we can vote for, but the corporation also has a variety of undemocratic governing mechanisms that make those votes much less meaningful. And the biggest problem is that many of the shareholders are part of blocs that make money from the current unsustainable practices of the corporation and vote in bad boards that rob us blind so they can make more money.

Once upon a time, Americans were shareholders of government. Today Americans are consumers of government.

The current incarnation of the American Republic (is it the Fourth or the Fifth incarnation? At least the Europeans have the good grace to tack on those numbers) is primarily a provider of domestic services and international defense. This is a striking contrast from the older American Republic where the government provided domestic defense and not much else.

It’s simplest to think of a thing in terms of its function. With the majority of Federal spending going to Social Security and Medicare, our government is essentially an insurance company, taking a percentage of salaries and “investing” that money to provide a social safety net. Except the money isn’t invested, it’s squandered, and much of it goes to people who are not paying into the system.

As insurance companies go, our government is completely financially unreliable and untrustworthy, its payouts are poor, its customer service is terrible and the people running it would be in a jail cell if they were serving on corporate boards.

To understand what our government is, imagine a wasteful non-profit obsessed with Third World children, merged with some kind of domestic poverty charity, merged with an insurance company, attached to a bunch of umbrella trade and regulatory groups for entire industry with a huge military arm that exists to stabilize troubled regions for the business community and occasionally does pro bono genocide interventions.

This Frankenstein America monster is what the current Republic looks like and the people running it insist that this unwieldy beast, its bulky body that can hardly walk in a straight line and its deviant brain, are a massive step forward into the future. Well Dr. Frankenstein thought the same thing and whether it’s the Tea Party or OWS, there are no shortage of peasants with pitchforks out there.

The newest addition of the DSM-5 manual is scheduled for publication in May 2013. The DSM is used by clinicians to determine whether a client or patient meets or does not meet the criteria for a particular diagnosis.

With a new edition comes a potential new definition of autism that can be critical for many people, especially regarding funding. Psychiatrists and parents have voiced concerns that the new definition of autism in the DSM-5 will exclude many people from both a diagnosis and state services.

As with many of the disorders in the DSM-5, new diagnostic criteria and classifications are being proposed and reviewed. A new requirement for Autism Spectrum Disorder(ASD) diagnosis is that a child must exhibit symptoms from every area of the DSM diagnostic criteria.

One of the most discussed changes in the DSM-5‘s definition of ASD is the removal of Asperger’s syndrome and PDD-NOS as individual diagnoses. Under the new diagnostic criteria, Asperger’s and PDD-NOS will come under the umbrella of ASD. A child whose diagnosis is currently Asperger’s syndrome would receive a new diagnosis of Autism Spectrum Disorder, with specifiers, such as “autism spectrum disorder with fluent speech” or “autism spectrum disorder with intellectual disability.”

Who will this affect?

Tens of thousands of people receive state-backed services to help offset the disorders’ disabling effects, which include severe learning and social problems.

Parents are justifiably concerned that any tightening of the Autistic Spectrum diagnosis will threaten their children’s eligibility for vital services. The Global and Regional Asperger Syndrome Partnership has launched a campaign to lobby the DSM-5 task force to keep a broad-spectrum concept of autism. The campaign urges those affected to contact the DSM-5 Committee to protest the newest changes.

Potential consequences

The overriding concern is what these changes mean for students receiving autism services through their Individualized Education Program. For students who currently have an IEP due to a diagnosis of Asperger’s syndrome, it seems that a change in services would be unlikely, except for the possibility of services for previously unmet needs being added.

The proposed changes are significant, and will affect not only those to whom the diagnostic labels are applied, but also the funding allocation systems and service delivery systems. In the middle of all this change are the parents who are trying to determine what this means for their children.

Backlash

Debate has also been rife among medical professionals. Many divisions of the American Psychological Association have banded together to issue an open letter and petition to the DSM-5 task force and American Psychiatric Association, urging that both associations should work together on any revisions of the DSM. They also publicly oppose various aspects of the proposed changes. Their letter states, “Psychologists are not only consumers and users of the manual, but we are also producers of seminal research on DSM-defined disorder categories and their empirical correlates.”

Both the medical profession and general public have generated a frenzy of petitions and campaigns against the proposed changes to the DSM autism criteria.

The APA, meanwhile, has reassured those affected that no previously covered group will be left out in the cold. The changes would involve merging several diagnoses currently listed separately in the DSM-5 into a single umbrella category of “Autism Spectrum Disorder.”

“The proposed criteria will lead to more accurate diagnosis and will help physicians and therapists design better treatment interventions for children who suffer from ASD,” said James Scully, MD, medical director of the APA, in a release.

Neurodevelopmental Work Group member Bryan H. King, MD, believes that with the changes “we are going to be able to better characterize individuals with autism, in part because of clearer criteria that have been written to better account for people across the age span. And one could argue that this will actually make it easier for adolescents and adults, and even young children potentially, to meet criteria for diagnosis than was previously the case.”

What can I do?

Parents, caregivers and special education advocates must become knowledgeable about the proposed diagnostic revisions for Autism Spectrum Disorder and the possible effects on students receiving autism-related services. It is imperative that attention be given to the APA’s development of ASD secondary feature definitions, and the specific qualifiers that will be attached to an autism diagnosis. Becoming educated about these changes and additions is necessary so that you can be your student’s best, most effective educational and medical advocate.

Internet usage is something many of us have been thinking about in this post-Asifa world. I am not writing this to debate the effectiveness of Asifa-type events but only to suggest that since the Citi Field Asifa people aren’t as reluctant to talk about the Internet as they use to be. We are discussing, in a positive manner, Internet safety while projects such as the Internet Shiur series created by Rabbi Gil Student and Dovid Teitelbaum are educating and informing people about Internet use.

While I am not as active as some people, I do spend time online. I am told I have a “web presence” and my digital footprint does include blogs, Facebook, and a little Twitter. I have decided, however, that I need to become less socially connected.

Over the past number of weeks I have heard and read several ideas I believe are worth sharing.

Rav Moshe Weinberger (Congregation Aish Kodesh, Woodmere, New York) has mentioned in several of his shiurim over the years that one of the greatest problems facing us today is the effect of shallowness and depression. He says, quoting the author of Bilvavi Mishkan Evneh, that atzilus (depression or sadness) is really the feeling of not being connected to the Makor Chaim, the true source of life.

When Rabbi Zechariah Wallerstein (founder and director of Ohr Naava) spoke at the Asifa for the Five Towns, he described the Internet as being an artificial world that becomes attractive because we don’t find meaning in this world.

Most recently I heard Rabbi Jonathan Rosenblum (founder and director of Jewish Media Resources) address a group in Chicago and he mentioned that in a study of high school students in Israel more than half the respondents said their goal in life was “to be famous.” He observed that one of the attractions of Facebook and Twitter is that we want people to pay attention and notice us.

His words hit home. Most of my own activity on Facebook wasn’t spent searching for people who needed Tehillim said on their behalf (Facebook happens to be a great way for people to let others know if and for whom tefillos are being requested) but rather to validate my own life. While I think there is value in social networking, connecting with old friends and sharing good news, I realized I was becoming a little too socially connected.

I decided to take action. The small steps I’ve taken so far are not original in any way but they do seem to be working for me. I deleted the Facebook and Twitter apps from my phone (but not Facebook Messenger). Getting rid of those two apps has not only made me feel like less of an eved, a slave, to my phone, it has helped me reclaim the power of bechira, free will.

When I come home from work in the evening I have started putting my smartphone in “airplane” or “flight” mode, which turn off all wireless signals. I do this so that I am not distracted by my phone when I am with my family. After my kids go to sleep, I either turn my phone back on to look at my e-mails or I check the old fashioned way, on a computer. And I now only go onto Facebook every two or three days.

As the days get closer to Tisha B’Av and I mourn the loss of the place where Knesses Yisrael had the strongest connection with Hashem, I can’t help but think about the importance and the value of true connections.

Neil Harris lives in Chicago, where he works in the healthcare industry. When time allows he maintains a blog called Modern Uberdox at www.uberdox.blogspot.com.

Most discussions of the recent gathering at Citi Field have focused on the logistics of the event and the topic – the dangers of the Internet. With such a focus, however, we may very well be missing something of great importance. What struck my attention was the name of the organization staging the event: Ichud HaKehillos Letohar HaMachaneh, or the Union of the Communities for the Purity of the Camp.

It is my understanding that though this is far from the first use of the expression “the Purity of the Camp,” it has risen to prominence only in recent decades. I think it is a telling term, both for what it says and what it leaves unmentioned. And I would suggest that understanding its use might help us make some sense of contemporary dynamics in the Orthodox world.

What are the goals of purification, and how might the goals be different for an organization dedicated to making the camp upright as compared with one seeking to purify it?

Purification aims to remove impurities, to make something 100 percent unadulterated. It is about perfection. Anything threatening such perfection must be identified and eradicated. As with disease, a small infection left uncontained can sicken the entire body.

The emphasis, in some communities, on purity and purification might help explain why, for example, the Internet is seen as deserving of a stadium-scale event. With the easy availability of pornography and foreign ideas, the Internet is a danger to ensuring purity.

It also, I would suggest, explains a number of other phenomena: the increase in recent years of book bans to ensure ideological purity; the homogenization of Jewish day school education, with parents seeking to place their children in increasingly less diverse environments – ideological bubbles where they will not be exposed to those children, let alone those ideas, not certified as pure; and the narrowing of the diversity of Torah perspectives into one true and exclusive interpretation (by which many people of different perspectives all proclaim that Jewish unity is achieved only when everyone agrees with me).

We can now also explain the efforts over the last decade to make ever more stringent the requirements for conversion, and the attempts to annul retroactively, years later and en masse, previously unsuspicious conversions. This is only possible when there is a fear of admitting impure elements and not rooting out hidden impurities. And some people thus fear that the purity of the camp is under grave threat.

These issues and the generally widening distrust over kashrus and many other matters are all about purity and impurity – and when purity is the highest value, the slightest impurity is the greatest danger.

Yet there is something critical missing here: morality.

A focus on – an obsession with – purity does not require any particular concern with morality. And so now perhaps we can understand why the dangers of the Internet appear to be a greater concern among some people than the dangers of child abuse. Even why reporting abusers to secular authorities can be seen as worse than the abuse itself – the former, involving the impure secular world, threatens purity in a way that abuse, within the community of the pure, does not. It might also be why all sorts of financial crimes seem so common – they do not threaten purity and perhaps are, according to some odd logic, justified by strengthening the purity of the community.

Too often these days it appears that some of us have lost touch with very basic moral values, including respecting the dignity of all of God’s creations. If we ask ourselves whether or not our actions meet a standard of yashrus/uprightness instead of tohar/purity, perhaps we would be more reluctant to undertake some of these actions.

How did purity become raised to such exalted status anyway, and become applied to the Camp or Community rather than to individuals in their religious improvement?

The weekday Amidah, the central prayer of Jewish worship, includes among all its praise, requests and thankfulness nothing about purity. We pray for tzedek and wisdom and a number of other character traits and blessings, but not for purity.

We often talk about the importance Kiddush Hashem and the horror of Chillul Hashem. When we elevate purity above other values such as yashrus, then we also rank it above avoiding its opposite, and end up justifying chillulei Hashem in the name of purity – after all, it need not matter what the impure think of us, and it becomes irrelevant when impure Jews and non-Jews witness what to most observers appear to be lapses in morality and desecrations of God’s name.

Our understanding of Autism Spectrum Disorders has advanced rapidly in recent years. Autism spectrum disorders (ASDs) are a family of neurodevelopmental conditions characterized by unusual patterns in social interaction, communication, and range of interests and activities. While this profile is generally applicable for the entire ASD population, much variation actually exists. No two individuals exhibit the exact same symptoms and as such, ASD is a heterogeneous disorder.

Autism spectrum disorders can often be reliably detected by the age of 3 years, and in some cases as early as 18 months. Studies suggest that many children eventually may be accurately identified by the age of 1 year or even younger. The appearance of any of the warning signs of ASD is reason to have a child evaluated by a professional specializing in these disorders.

By age 3, most children have passed predictable milestones on the path to learning language; one of the earliest is babbling. By the first birthday, a typical toddler says words, turns when he hears his name, points when he wants a toy, and when offered something distasteful, makes it clear that the answer is “no.”

Some children diagnosed with ASD remain non-verbal throughout their lives. Some infants who later show signs of ASD coo and babble during the first few months of life, but they soon stop. Others may be delayed, developing language as late as age 5 to 9. Some children may learn to use communication systems such as pictures or sign language.

Children who do speak often use language in unusual ways. They seem unable to combine words into meaningful sentences. Some speak only single words, while others repeat the same phrase over and over. Some ASD children mimic what they hear, a condition called echolalia. Even though there are children with no ASD who go through a stage where they repeat what they hear, it usually is gone by the time they are 3.

Some mildly affected children may have minor delays in language. Some seem to be very verbal with unusually large vocabularies, but have great difficulty in sustaining a conversation. The usual “give and take” of conversation is difficult for them. They often carry on a monologue on a favorite subject, giving no one else an opportunity to comment. They have other difficulties including the inability to understand body language, tone of voice, or “phrases of speech.” Sarcastic expression might often be misinterpreted. For example, if someone tells them, “Oh, that’s just great,” they would take the words literally, believing the speaker meant to tell them that it really IS great.

The body language of ASD children is also difficult to understand. Facial expressions, movements, and gestures rarely match what they are saying. Also, their tone of voice fails to reflect their feelings. A high-pitched, sing-song, or flat, robot-like voice is common. Some children with relatively good language skills speak like little adults, and do not pick up on the “kid-talk” approach so common with their peers.

People with ASD are at a loss to let others know what they need because they cannot make understandable gestures or lack the language to ask for things. Because of this, some may simply yell or just take what they want without asking. ASD children have great difficulty learning how to get through to others and express their needs. As ASD children grow up, they become more cognizant of their difficulties in understanding others and in making themselves understood, which can result in more anxiety, depression or maladaptive behaviors.

Studies show that augmentative devices are a great help in fostering language in children with autism and other disabilities, and have achieved remarkable results.

Augmentative communication is all of the ways we communicate other than speech. It includes:  Gestures  Sign Language  Vocalizations  Facial Expression  Communication Displays (boards)  Communication Devices A group of aids, starting from simple, notebook-size plastic boxes to more high-tech devices that resemble an IPod or BlackBerry, has been developed to help those with autism to express their needs. These devices range in price from about $100 to several thousand dollars. Most are portable and the simpler ones are also very durable and well-constructed, a real advantage for children with autism.

Augmentative and alternative communication (AAC) devices are tools to allow people with severe or significant speech impairments to express themselves. These devices are used as a method to allow children to exactly say what they want and as fast as they can. It’s a valuable communicator that allows them to express their feelings, thoughts, ideas and get their needs met. These devices can range from low tech picture cards to high end speech generating devices.

However, regardless of low or high tech, the most important questions about the suitability of an AAC Device is: • can the person say precisely what they want • can they say it quickly